Flexible Spending Accounts (FSA) – All Locations

Flexible Spending Accounts offer employees a way of making pre-tax payroll deductions for qualified medical and/or dependent care expenses.

**The 2021 Health Care & Limited Purpose FSA Maximum is 2,750 and there is no carryover maximum with BASIC from 2021 to 2022.

1. Health Care FSA Plan Benefits

• Reimburses health care expenses, incurred by you and your tax dependents, not eligible to be paid by insurance.
• Employees enrolled in the CIGNA CDHP with an HSA are not eligible for this plan, and may enroll in a Limited Purpose FSA.

2. Limited Purpose FSA Plan Benefits (Mainland Only)

• Reimburses dental and vision services.
• 2022 Maximum annual election amount is $2,850
• 2023 Maximum annual election amount is $3,050
• Available only to individuals who enroll in the CIGNA CDHP/HDHP plan

3. Dependent Care FSA Plan Benefits

• Reimburses dependent care expenses that allow you and your spouse to work. This is NOT for dependent health care expenses.
• 2022 and 2023 Maximum annual election is $5,000.

Enrollment

• Newly eligible employees may enroll within 31 days of hire
• An individual may change their FSA contributions within 31 days of a qualifying change in family status.
• During Open Enrollment, an individual must re-enroll to continue participation in the FSA the following year.

File a Claim

You can be reimbursed for expenses with service dates from January 1 through December 31, while actively making contributions to the plan. The date you pay for an item or service is irrelevant.

• Submit claims directly to the plan provider BASIC
• Attach the appropriate documentation including: an explanation of benefits (EOB), receipt, or invoice
• Documentation must include: provider or full name of product, patient name, amount, and date(s) of service.
• Canceled checks will not be accepted in lieu of an itemized bill or receipt
• Statements showing only a previous balance are not acceptable documentation
• Individuals may be reimbursed up to the full annual election amount regardless of the amount contributed to the account on the health and limited purpose plans.
• All eligible funds for the plan year  must be claimed within 90 days with the Third Party Administrator by the end of the plan year. If an individual retires or ceases participation in the plan, dates of service must be prior to the active participation end date. Under Internal Revenue Service (IRS) regulations, for plan year 2022, any funds not claimed from the Healthcare FSA within these periods over $570 (Plan year 2023 will be $610) remaining in your account at the end of the plan year and have not incurred expenses for which to claim that money, are forfeited.